Journal of Stomatology Oral and Maxillofacial Surgery最新文献

The anterolateral thigh (ALT) flap is a commonly used donor site for reconstructive surger, especially in head and neck reconstructions. The flap's success is primarily determined by the quality and quantity of its perforating vessels, which is why clinicians typically prefer harvesting from a healthy leg with intact vascular anatomy. Poliomyelitis typically causes unilateral lower limb paralysis, resulting in muscle atrophy and deformities. Harvesting the ALT flap from the paralyzed leg could preserve the function of the unaffected limb, but this approach is complicated by the atrophy and deformities present in the affected leg, creating substantial challenges. We here report the successful ALT flap harvesting from the polio-affected leg in a 55-year-old male patient for the reconstruction of a tongue defect. The patient diagnosed with Left tongue squamous cell carcinoma, and underwent tongue cancer excision and a modified radical neck dissection. The flap survived and healed well with the patient's tongue tissue. The wound at the donor site on the thigh also healed well. There were no complications observed in either the flap or the donor site. Our experience suggests that harvesting from the paralyzed leg is a safe and feasible procedure that preserves the function of the unaffected limb and may enhance the postoperative quality of life for polio survivors.

Background: Complex craniofacial trauma is defined as those traumatic injuries that are not responding to initial treatment and may involve chronic infection, tissue exposure, and soft tissue contusions. Typical reconstruction using a Y-shaped microvascular venous anastomotic free flap is labor intensive. Although free flap grafts have been used in many applications, their use for combined microvascular anastomotic therapy remains an unexplored but attractive possibility.

Purpose: Correcting facial contour trauma is challenging because it requires careful planning of flap design, composition, and ancillary procedures METHODS: This study analyzed a retrospective cohort of 28 craniofacial trauma patients (18 males; 10 females) who underwent Y-shaped microvascular venous anastomosis free flap grafting for treatment of the defects between January 2020 and January 2022, and were followed up for more than 6 months after the procedure.

Results: The causes of defects were high-voltage electrical injuries (n = 12), after excision of scalp malignant tumors (n = 8), grade III burns (n = 6), and trauma (n = 2). By adjusting the height of the tissue and the different tissue components, the flaps were designed in three dimensions by contour mapping so that they had different thicknesses depending on the defect. Custom-sized flaps with a reliable envelope were taken while minimizing the loss of overlying skin. 6 flaps were based on two perforators, and another 19 were based on one perforator. Nine flaps were harvested in an inlay fashion. All flaps were fully viable and no donor lesions were present in any case. Contour and symmetry were improved in all patients, and all grafted patients were evaluated for pre- and postoperative aesthetic restoration.

Conclusions: Our findings suggest that the Y-shaped microvascular venous anastomosis free flap approach may be a reliable alternative for aesthetic reconstruction of facial contour trauma.

Objective: Guided implant surgery using three-dimensional (3-D) planning software and 3-D printed surgical guides has become a critical tool for enhancing accuracy. This study aims to determine the minimum guide hole height necessary to maintain implant placement accuracy.

Materials and methods: Ten maxillary models with edentulous areas were created using CT and optical scan data. Six sites (for each model) were prepared for implant placement with surgical guides fabricated using a 3-D printer. Sixty implants were placed using these guides and divided into five groups according to the guide hole height (1 to 5 mm). After the placement, digital impressions were taken to assess the accuracy of implant positioning. Deviations between planned and actual implant positions were investigated using computer software, and data were statistically analyzed using ANOVA and Kruskal-Wallis tests.

Results: Guide holes with 1 mm height (Group Ⅰ) resulted in the highest 3-D deviations (1.12 ± 0.36 and 1.99 ± 0.74 mm at the coronal and apical positions, respectively), with significant errors at the implant apical position compared to groups with taller guide holes (Groups Ⅳ and Ⅴ) (p = 0.005). There were no significant deviations between the 3 mm and 5 mm guide hole heights, with no statistical differences between groups at the x, y, and z-axis in the implant position.

Conclusion: A comparison between the group with a guide hole height of 5 mm on one side and the group with a height of 1 mm on both sides revealed a significant difference in implant placement accuracy.

Introduction: Arterialized venous flap, like any other flap, will undergo an ischemic reperfusion injury during its transfer process. To overcome this, ischemic preconditioning can be done to provide protection and enhanced flap survival. One of the reliable parameters of flap survival is its temperature. However, there was no recorded data regarding AVF's temperature or its monitoring. This research aimed to demonstrate the temperature effect of ischemic preconditioning on arterialized venous flap.

Method: Male Wistar Rats were randomly divided into 4 groups, consisting of 6 negative control groups, 8 positive control group (PS) rats that underwent an anastomosis of the superficial epigastric artery to the superficial epigastric vein, 8 experimental rat group 1 (EX1) that underwent 3 cycles of 5 minutes pre-anastomosis clamping with 3 cycles of 5 minutes each, and 8 experimental rats' group 2 (EX2) with 3 cycles of 10 minutes. Flap's temperature was observed preoperatively and postoperatively from day 1 to day 7, day 14, and day 21 with an android-based thermal camera and recorded in Celsius degrees.

Results: All the flaps (N= 26) were vital. The temperature drop was seen in all anastomosed flaps compared to the negative control (30.37 vs. 25.08 vs. 23.77 vs. 25.27, p<0.05). A significant increase in temperature occurred on days 4 to 6 in Ex1 (33.62±1.820, 33.62±1.820, 32.40±1.627; p<0.05). As in the temperature trend, Ex2 is shown to have a stable temperature from day 2 until 21.

Conclusion: This study has recorded an increase in temperature in the early days of the creation of the arterialized venous flap at various timings of ischemic preconditioning. The flap's monitoring was easily observed with a thermal camera that can be implemented in humans.

Introduction: Orbital fractures are common among maxillofacial injuries. The primary objective of this study was to investigate the clinical and radiographic characteristics of pure orbital blowout fractures (OBFs) and their association with post-traumatic diplopia. The secondary objective was to identify predictors of diplopia in pure OBFs.

Method: This retrospective cross-sectional study analysed the clinical records and computed tomography (CT) data of patients with pure OBFs, treated between 1st January 2008 and 28th February 2022 at a single tertiary trauma centre in Klang Valley, Kuala Lumpur, Malaysia. Data collected included demographic characteristics and the aetiology of OBFs. Specific factors such as fracture site, size, type, and soft tissue involvement were assessed using CT images, which were converted to DICOM format and analysed with the OsiriX v4.1.2 software. Diplopia was measured using the Hess area ratio percentage (HAR%).

Results: The analysis included records of 70 patients. Motor vehicle accidents (MVAs) accounted for 61.4 % of pure OBFs. The largest fracture observed involved both the orbital floor and the medial wall, with a mean size of 6.40 ± 3.05 cm². Among the patients, 41.6 % had Type 3 fractures, and 50 % (n = 35) had 2-point muscle-soft tissue contact. Fracture size, site, type, and muscle contact were all significantly associated with HAR92 % (p < 0.05). Logistic regression revealed that Type 3 fracture was the significant predictor of diplopia (HAR < 92 %), with an odds ratio of 19.80 (95 % CI: 5.76-68.07, p < 0.001).

Conclusion: Fracture site, size, type, and muscle involvement were important factors associated with diplopia. Among these, Type 3 fractures were identified as the primary predictor of HAR < 92 %.

Soft tissue deficiency around dental implants can negatively impact outcomes in terms of esthetics and long-term stability. While autogenous connective tissue grafting is still considered the gold standard treatment, alternative approaches are being proposed primarily to enhance patient comfort and avoid invasive procedures such as two-sites surgeries using xenogeneic collagen matrices. Despite the advantages, the quality of the regenerated tissues remains unpredictable and, in many cases, questionable, highlighting the need for alternative and innovative approaches. After introducing in a previous technical note, the "HAT-TRICK" technique, to address these challenges in pontic sites, the present study highlights the "HAT-TRICK" technique for thickening the keratinized gingiva in both immediate and delayed implant placement sites within the esthetic zone. The "HAT-TRICK" technique is demonstrated through two clinical cases, accompanied by a digital comparison conducted at baseline and after one year of follow-up in order to assess and quantify the augmented areas.

Objectives: This study aimed to evaluate with ultrasonography (US) the location of GPF, the course of the GPA, and to measure palatal fibromucosa thickness.

Materials and methods: This in vivo experiment was conducted on a group of healthy, young Turkish subjects. Using the US, the localization of the GPF, its diameter and opening type, maximum flow velocity (Vmax) and collateral branches (CB) of the GPA, and the thickness of the palatine mucosa were evaluated. The distance between the probe and the gingival margin (GM-P) was also measured to determine the course of GPA. Statistical analyses were performed using the chi-square test and the independent sample t-test, with the significance level set at 0.05.

Results: The study included 31 participants (16 females, 15 males; mean age, 23.77±0.92). GPF predominantly showed between the second and third molars (n = 15;48.4 %) and exhibited an anterior opening type(n = 25;80.6 %). The average diameter of GPF measured 5.52±1.76 mm, with a Vmax value of GPA at 14.39±5.07 cm/sec. Collateral branches were primarily observed at the first molar level (n = 23; 74.2 %). No statistically significant gender differences were noted in localization or opening type. However, GM-P at the second molar level was significantly greater in men than women(p < 0.05).

Conclusion: In understanding the anatomical structure of the palate, the US provides important clinical results regarding the anatomical measurement of the GPF, the GPA, and adjacent fibromucosa.

Objective: To investigate the reparative effect of hypoxia pretreated hAMSCs on radiation-induced damage to salivary gland function in mice.

Methods: hAMSCs were separated from human amniotic tissues by mechanical and enzymatic digestion methods and a 15 Gy electron beam was used to locally irradiate the neck of mouse to create a salivary gland injury model. The mouse models were randomly divided into four groups: control group, IR+PBS group, IR+Nor group and IR+HP group.

Result: Two months after hAMSCs injection, the saliva flow of mice in the IR+PBS group was significantly lower than that of the control group (P < 0.05). The saliva flow of mice in the IR+Nor group and IR+HP group were significantly increased compared to the IR+PBS group (P < 0.05). The cell apoptosis rate of the IR+PBS group was sensibly higher than that of the blank control group (P < 0.05). The cell apoptosis rates of the IR+Nor group and the IR+HP group were lower than that of the IR+PBS group. In addition, the apoptosis rate of the IR+HP group was lower than that of the IR+Nor group (P < 0.05). The changes of IOD of α-Amy in each group showed that the expression of α - Amy in the IR+PBS group was significantly lower than that in the blank control group (P < 0.05). Compared with the IR+PBS group, the IR+Nor group and the IR+HP group showed an obvious increase in the expression of α-Amy (P < 0.05).

Conclusion: Low oxygen pretreatment of hAMSCs could more effectively repair the function of radiation-induced salivary gland compared to normoxic cultivation.

Objectives: This study aimed to assess the alterations in condylar positioning in adult skeletal Class I patients with unilateral posterior crossbite following microimplant-assisted rapid palatal expansion (MARPE) treatment.

Methods: This retrospective study involving 30 participants (10 males, 20 females) with an average age 22.9 ± 4.2 years, ranged from 18.1 to 30.9 years, who were treated with a customized microimplant-supported rapid palatal expander. Pre-expansion and post- comprehensive orthodontic treatment CBCT images (20-26 ±2.1months) were analyzed to assess the condylar changes before and after treatment. We measured the temporomandibular joint (TMJ) in the three dimension in terms of: (1) The position and angle of the mandibular condyles; (2) How centralized the condyles were in their particular mandibular fossae; and (3) The volume of the TMJ and the joint spaces. To evaluate the differences between the T1 and T2 samples, we used the paired t-test and the Wilcoxon signed rank test.

Results: Before treatment, minor differences were noted in the anterior joint space (AJS), superior joint space (SJS), and anteroposterior condylar joint position (APCJP) between the crossbite and non-crossbite sides, though these differences were not statistically significant. Post-treatment, the condyles on both sides assumed a more posterior position, yet significant asymmetry in the AJS persisted (P < .05). The crossbite-side condyle also showed a tendency to rotate toward the non-crossbite side in the anteroposterior direction. While MARPE affected specific aspects of condylar positioning, achieving complete alignment remained challenging.

Conclusion: This study provides insightful observations on the enduring impacts of MARPE on TMJ spaces and position in adult patients suffering from a unilateral posterior crossbite.

Objective: To evaluate the clinical outcomes of surgical and non-surgical treatments for actinic cheilitis (AC) over a four-decade period and to introduce a novel Clinical Index for the Treatment and Control of Actinic Cheilitis (CITC-AC) for improved patient stratification and management.

Materials and methods: A retrospective cohort study analyzed 151 patients diagnosed with AC treated at a university clinic between 1980 and 2020. Sociodemographic, clinical, and histopathological data were collected. Treatments were categorized as sun protection (SP), topical corticosteroids (TC), surgical removal (SR), and vermilionectomy. Therapeutic outcomes, recurrence rates, and malignant transformation were assessed. The CITC-AC was developed to guide clinical decision-making based on stratified risk.

Results: A total of 87% of patients achieved therapeutic resolution. Recurrence was observed in 13%, and malignant transformation occurred in 7% of cases. Surgical treatments, particularly vermilionectomy, demonstrated superior outcomes with no recurrence or malignancy. Non-surgical treatments, including the novel use of Omcion-A Orabase, achieved favorable outcomes but exhibited higher recurrence rates. The CITC-AC provided a structured framework for stratifying patients by severity and risk, aiding in the selection of appropriate interventions and follow-up schedules.

Conclusions: This study highlights the importance of individualized treatment strategies and consistent follow-up in AC management. While surgical interventions remain the gold standard for advanced cases, non-surgical treatments are effective for early-stage lesions. The CITC-AC offers a practical tool for optimizing patient care and reducing progression to squamous cell carcinoma (SCC). Prospective studies are needed to validate its applicability across diverse clinical settings.